Abstract

Descemet membrane endothelial keratoplasty (DMEK) is the most efficacious partial endothelial keratoplasty, offering the highest likelihood of 20/20 vision and the shortest recovery times. However, current devices do not effectively address the difficult step of unrolling the corneal graft within the eye which is the greatest barrier to DMEK adoption. Here, we present the design, development, and testing of a novel device that simplifies and standardizes DMEK graft transplantation. The patent-pending cartridge facilitates the trifold technique, a graft preparation method that allows the graft to naturally unroll in the eye and reduces time-consuming manipulation steps required in alternative techniques. Injection molding was used to manufacture devices which were tested with research-grade corneal grafts. The cartridge's design allows it to fit into a typical corneoscleral incision, maintains trifolded grafts (p = 0.006), and reduces endothelial cell loss (ECL) (p = 0.049). These results demonstrate that the device introduced here is suitable for DMEK and may simplify this procedure for corneal surgeons.

References

References
1.
Eye Bank Association of America
,
2017
, “
2016 Eye Banking Statistical Report
,” Eye Bank Association of America, Washington, DC,
Report
.http://restoresight.org/wp-content/uploads/2017/04/2016_Statistical_Report-Final-040717.pdf
2.
Daoud
,
Y.
,
Munro
,
A. D.
,
Delmonte
,
D. D.
,
Stinnett
,
S.
,
Kim
,
T.
,
Carlson
,
A. N.
, and
Afshari
,
N. A.
,
2013
, “
Effect of Cornea Donor Graft Thickness on the Outcome of Descemet Stripping Automated Endothelial Keratoplasty Surgery
,”
Am. J. Ophthalmol.
,
156
(
5
), pp.
860
866
.10.1016/j.ajo.2013.06.030
3.
Hannush
,
S.
,
2016
, “
Perfecting Posterior Corneal Grafts
,”
Review of Ophthalmology
,
Jobson Medical Information
,
New York
.
4.
Fernandez
,
M.
, and
Afshari
,
N.
,
2010
, “
Endothelial Keratoplasty: From DLEK to DMEK
,”
Middle East Afr. J. Ophthalmol.
,
17
(
1
), p.
5
.10.4103/0974-9233.61210
5.
Dapena
,
I.
,
Ham
,
L.
,
Lie
,
J.
, and
Melles
,
G.
,
2009
, “
Descemet Membrane Endothelial Keratoplasty (DMEK): Two-Year Results
,”
Arch. Soc. Esp. Ofthalmol.
,
84
(
5
), p.
237
.https://www.ncbi.nlm.nih.gov/pubmed/19466684
6.
Heinzelmann
,
S.
,
Hüther
,
S.
,
Böhringer
,
D.
,
Eberwein
,
P.
,
Reinhard
,
T.
, and
Maier
,
P.
,
2014
, “
Influence of Donor Characteristics on Descemet Membrane Endothelial Keratoplasty
,”
Cornea
,
33
(
6
), pp.
644
648
.10.1097/ICO.0000000000000106
7.
Gorovoy
,
M.
,
2014
, “
DMEK Complications
,”
Cornea
,
33
(
1
), pp.
101
104
.10.1097/ICO.0000000000000023
8.
Lie
,
J. T.
,
Groeneveld-van Beek
,
E. A.
,
Ham
,
L.
,
van der Wees
,
J.
, and
Melles
,
G. R.
,
2010
, “
More Efficient Use of Donor Corneal Tissue With Descemet Membrane Endothelial Keratoplasty (DMEK): Two Lamellar Keratoplasty Procedures With One Donor Cornea
,”
Br. J. Ophthalmol.
,
94
(
9
), pp.
1265
1266
.10.1136/bjo.2009.171629
9.
Feng
,
M. T.
,
Price
,
M. O.
, and
Price
,
F. W.
,
2013
, “
Update on Descemet Membrane Endothelial Keratoplasty (DMEK)
,”
Int. Ophthalmol. Clin.
,
53
(
2
), p.
31
.10.1097/IIO.0b013e31827822b9
10.
Busin
,
M.
,
Leon
,
P.
,
Scorcia
,
V.
, and
Ponzin
,
D.
,
2016
, “
Contact Lens-Assisted Pull-Through Technique for Delivery of Tri-Folded (Endothelium in) DMEK Grafts Minimizes Surgical Time and Cell Loss
,”
Am. Acad. Ophthalmol.
,
123
(
3
), pp.
476
483
.10.1016/j.ophtha.2015.10.050
11.
Parekh
,
M.
,
Ruzza
,
A.
,
Ferrari
,
S.
,
Busin
,
M.
, and
Ponzin
,
D.
,
2016
, “
Preloaded Tissues for Descemet Membrane Endothelial Keratoplasty
,”
Am. J. Ophthalmol.
,
166
, pp.
120
125
.10.1016/j.ajo.2016.03.048
12.
Lohmeier
,
J.
,
Christy
,
J.
,
Chiang
,
E.
,
Barnes
,
K.
,
Cai
,
S.
,
Chen
,
C.
,
Subramanya
,
A.
,
Chaurasia
,
A.
,
Rosen
,
A.
,
Vora
,
P.
,
Durr
,
N. J.
,
Allen
,
R.
, and
Eghrari
,
A. O.
,
2018
, “
Viability of Descemet Membrane Endothelial Keratoplasty Grafts Folded in the Eye Bank
,”
Cornea
,
37
(
11
), pp.
1474
1477
.10.1097/ICO.0000000000001711
13.
Barnes
,
K.
,
Chiang
,
E.
,
Chen
,
C.
,
Lohmeier
,
J.
,
Christy
,
J.
,
Chaurasia
,
A.
,
Rosen
,
A.
,
Vora
,
P.
,
Cai
,
S.
,
Subramanya
,
A.
,
Durr
,
N.
,
Allen
,
R.
, and
Eghrari
,
A. O.
,
2019
, “
Comparison of Tri-Folded and Scroll-Based Graft Viability in Preloaded Descemet Membrane Endothelial Keratoplasty
,”
Cornea
,
38
(
3
), pp.
392
396
.10.1097/ICO.0000000000001831
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